Provider Demographics
NPI:1568073815
Name:PEACEFUL MINDS RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:PEACEFUL MINDS RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER5
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:443-759-8601
Mailing Address - Street 1:3704 S HANOVER ST UNIT 2A2B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-1773
Mailing Address - Country:US
Mailing Address - Phone:443-759-8601
Mailing Address - Fax:
Practice Address - Street 1:2733 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1734
Practice Address - Country:US
Practice Address - Phone:443-418-7064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness